Organization
LIFESTYLE CHANGES COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM L VIRTUE SR. (OWNER)
12087345230
Entity
Organization
Contact information
Practice address
371 LOCUST ST S, TWIN FALLS, ID 83301-7837
(208) 734-5230
Mailing address
371 LOCUST ST S, TWIN FALLS, ID 83301-7837
(208) 734-5230
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
ID
Other
Enumeration date
10/23/2013
Last updated
10/23/2013
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